Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 22613 | NE |
NPI | 1386693059 |
---|---|
Provider Name | Dr. James Willard Gallentine |
First Address | Lincoln, NE 68510-2471 |
Second Address | Lincoln, NE 68510-2471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1285683870 | (05) | IA |
47070309913 | (05) | NE |
H90354 | (02) | NE |